| NPI | 1184930588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0822) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 201399) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2012-08-10 |